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Risk Factors for Acquisition of Clostridium difficile–Associated Diarrhea among Outpatients at a Cancer Hospital

Published online by Cambridge University Press:  21 June 2016

Tara N. Palmore ,
SeJean Sohn ,
Sharp F. Malak ,
Janet Eagan  and
Kent A Sepkowitz
Tara N. Palmore
Affiliation:
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
SeJean Sohn
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Sharp F. Malak
Affiliation:
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Janet Eagan
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Kent A Sepkowitz*
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021., [email protected]
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Abstract

Background:

Clostridium difficile-associated diarrhea (CDAD) is an important infection in hospital settings. Its impact on outpatient care has not been well defined.

Objective:

To examine risk factors of ambulatory cancer patients with CDAD.

Design:

Case-control study.

Setting:

Memorial Sloan-Kettering Cancer Center, a tertiary-care hospital.

Methods:

Cases of CDAD among oncology outpatients from January 1999 through December 2000 were identified via positive C. difficile toxin assay results on stool specimens sent from clinics or the emergency department. A 1:3 matched case-control study examined exposures associated with CDAD.

Results:

Forty-eight episodes of CDAD were identified in cancer outpatients. The mean age was 51 years; 44% were female. Forty-one (85%) had received antibiotics within 60 days of diagnosis, completing courses a median of 16.5 days prior to diagnosis. Case-patients received longer courses of first-generation cephalosporins (4.8 vs 3.2 days; P = .03) and fluoroquinolones (23.6 vs 8 days; P < .01) than did control-patients. Those receiving clindamycin were 3.9-fold more likely to develop CDAD (P < .01). For each additional day of clindamycin or third-generation cephalosporin exposure, patients were 1.29- and 1.26-fold more likely to develop CDAD (P < .01 and .04, respectively). The 38 CDAD patients hospitalized during the risk period (79.2%) spent more time as inpatients than did control-patients (19.3 vs 9.7 days; P <. 001).

Conclusions:

Antibiotic use, especially with cephalosporins and clindamycin, and prolonged hospitalization contributed to the development of CDAD. Outpatient CDAD appears to be most strongly related to inpatient exposures; reasons for the delayed development of symptoms are unknown.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 8 , August 2005 , pp. 680 - 684
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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